AMA Journal Of Ethics Case

AMA Journal of Ethics Case

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The case study chosen from the AMA Journal of Ethics Case is “How should clinical ethics consultants support parents’ decision making?” The issue raised in this article is the misinterpretation of the role of ethics consultant in the shared decision making. It has also been mentioned that how there is a gap in the clinical setting for the utilization of the patient decision aids ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"8roNmfmk","properties":{"formattedCitation":"\\super 1\\nosupersub{}","plainCitation":"1","noteIndex":0},"citationItems":[{"id":424,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/66A62YKV"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/66A62YKV"],"itemData":{"id":424,"type":"article-journal","title":"How Should Clinical Ethics Consultants Support Parents’ Decision Making?","container-title":"AMA Journal of Ethics","page":"831-837","volume":"21","issue":"10","source":"journalofethics.ama-assn.org","abstract":"Clinical ethics consultants (CECs) frequently provide guidance to parents feeling grief and uncertainty. In response to a case in which a CEC works with parents making end-of-life decisions for their child","DOI":"10.1001/amajethics.2019.831.","ISSN":"2376-6980","author":[{"family":"Feder","given":"Katherine J."},{"family":"Firn","given":"Janice I."}],"issued":{"date-parts":[["2019",10,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} 1. However, decision making in the end of life cases is a tougher choice as parents still want to provide that is best for their child. Their logical thinking capabilities are clouded by emotions and stress. On the other hand, ethics consultants are emotionally less connected with the patient and decisions made by him would have no bias and thorough assessment of short term long term effects of any clinical decision. The decisions made by the consultants should be consulted before finalizing based on the cultural values and noms of the patient and their family.

Nurses have a significant role in establishing relationships with the patients and their families, community and other populations and service providers in a multi cultural diverse health care setting. The relationship of patient and nurse is primarily the exchange of information which is important for shared decision making. However, the expectations of the patient’s family is hard to meet. The ethical consultants and nurses need to discuss the case together and then come to any conclusion that can be shared with the patients or other involved stakeholders ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"mtrZjbjU","properties":{"formattedCitation":"\\super 2\\nosupersub{}","plainCitation":"2","noteIndex":0},"citationItems":[{"id":421,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/US2WUFEA"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/US2WUFEA"],"itemData":{"id":421,"type":"article-journal","title":"Shared Decision-Making for Nursing Practice: An Integrative Review","container-title":"The Open Nursing Journal","page":"1-14","volume":"12","source":"PubMed Central","abstract":"Background:\nShared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice.\n\nObjective:\nTo understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings.\n\nMethods:\nAn integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings.\n\nResults:\nFifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making.\n\nConclusion:\nA comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.","DOI":"10.2174/1874434601812010001","ISSN":"1874-4346","note":"PMID: 29456779\nPMCID: PMC5806202","title-short":"Shared Decision-Making for Nursing Practice","journalAbbreviation":"Open Nurs J","author":[{"family":"Truglio-Londrigan","given":"Marie"},{"family":"Slyer","given":"Jason T."}],"issued":{"date-parts":[["2018",1,22]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} 2. Nurses along with these consultants have to look for the greater good and that might even go against the wishes of the parents. Yet, majority of the work is entirely based on learning the ethically defensible decisions.

The possible solution in order to over the particular issue is to consider the process of shared decisions making and other legal and ethical values. The implementation of such practices where all the related health care professional in making a combined decision should be made mandatory. The patient’s autonomy should be given its due consideration along with measuring parent’s views. The ethial consultant should present the positive and negative implications of many choices that are available in any cases. The assessment of the greater good and societal pressure can also prove affective in making decisions. There is also a need for the consultants to include all the members and their opinion in order to make an informed decision without any element of biasness. In a healthcare setting, a single patien is basically the center of attention and their norms, values and culture should be given respect. As nurses spend majority of their time with their patients, patients are more comfortable sharing their thoughts and having discussions with the nurses realted to any ethically based decision.

This case provides insight for further research and assessment for the role of ethical consultants and the degree to which their involvement should be considerd appropriate. The same kinds of decisions made by the consultants might not be interpreted by different parents as the same. The process of making ethical decsions for the consultants and health care providers is limited due to the cultural barriers. They need to respect and give due importance to the values of any patient belonging from different society, religion or geographical location. They also need to get culturally intelligent education and learn the ethical and legal differences among different cultures ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"zaasWZVj","properties":{"formattedCitation":"\\super 3\\nosupersub{}","plainCitation":"3","noteIndex":0},"citationItems":[{"id":427,"uris":["http://zotero.org/users/local/9Hfkg8Y0/items/6F4SDKQM"],"uri":["http://zotero.org/users/local/9Hfkg8Y0/items/6F4SDKQM"],"itemData":{"id":427,"type":"book","title":"Legal and Ethical Issues for Health Professionals","publisher":"Jones & Bartlett Learning","publisher-place":"Burlington, MA","number-of-pages":"530","edition":"4 edition","source":"Amazon","event-place":"Burlington, MA","abstract":"Legal and Ethical Issues for Health Professionals, Fourth Edition is included in the 2015 edition of the essential collection of Doody†s Core Titles.Legal and Ethical Issues for Health Professionals, Fourth Edition is a concise and practical guide to legal and ethical dilemmas facing healthcare professionals in the real world today. Thoroughly updated and featuring new case studies, this dynamic text will help students to better understand the issues they will face on the job and the implications in the legal arena. With contemporary topics, real world examples, and accessible language, this comprehensive text offers students an applied perspective and the opportunity to develop critical thinking skills. Legal and Ethical Issues for Health Professionals provides an effective transition from the classroom to the reality of a clinical environment.New to the Fourth Edition• Features new case studies pulled from the news and how they pertain to healthcare ethics• Reviews the Affordable Care Act/ObamacareInstructor Resources: Lecture Outlines in PowerPoint format, Instructor†s Manual, Sample Syllabus, and a Test BankStudent Resources: Each new print copy includes Navigate 2 Advantage Access that unlocks a comprehensive and interactive eBook, student practice activities and assessments, a full suite of instructor resources, and learning analytics reporting tools.","ISBN":"978-1-284-03679-4","language":"English","author":[{"family":"Pozgar","given":"George D."}],"issued":{"date-parts":[["2014",12,17]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} 3. The role of ethics consultants is quite challenging in a culturally diverse health care setting and its responsibilities and should be clearly known to the patients and their families.

End Notes

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY 1. Feder KJ, Firn JI. How Should Clinical Ethics Consultants Support Parents’ Decision Making? AMA J Ethics. 2019;21(10):831-837. doi:10.1001/amajethics.2019.831.

2. Truglio-Londrigan M, Slyer JT. Shared Decision-Making for Nursing Practice: An Integrative Review. Open Nurs J. 2018;12:1-14. doi:10.2174/1874434601812010001

3. Pozgar GD. Legal and Ethical Issues for Health Professionals. 4 edition. Burlington, MA: Jones & Bartlett Learning; 2014.